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Laparoscopic segmental resection of the rectum for upper rectal intussusception caused by a giant rectal lipoma: A case report.

ABSTRACT: RATIONALE:Colonic lipomas are rare benign tumours, usually without any symptoms, and most occur in the caecum and ascending colon. We describe a patient with upper rectal intussusception caused by a giant rectal lipoma; no similar report of this type of case has been published. PATIENT CONCERNS:We report the case of a patient who suffered from repeated bloody stools. A wide pedicle polyp (size, 6.5?×?4.5?×?3.5?cm) was detected at the 15th centimetre of the anal canal via an electronic colonoscope. At the initial part of the rectum, intussusception caused by a 6.5-cm fat-density mass was observed via abdominal contrast-enhanced computed tomography. DIAGNOSIS:Upper rectal intussusception caused by a giant rectal lipoma. INTERVENTIONS:Due to the large size of the polyp, an endoscopic polypectomy could not be performed. We performed laparoscopic segmental resection of the rectum (with preservation of the left colic artery [LCA]). OUTCOMES:The patient was discharged on the 7th postoperative day without any complications, was monitored on a regular basis at our outpatient department and was free of symptoms at a 3-month follow-up visit. LESSONS:Laparoscopic segmental resection of the rectum with LCA preservation is safe and feasible for the treatment of upper rectal intussusception caused by a giant rectal lipoma.

SUBMITTER: Wei R

PROVIDER: S-EPMC6181545 | biostudies-other | 2018 Sep

REPOSITORIES: biostudies-other

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Laparoscopic segmental resection of the rectum for upper rectal intussusception caused by a giant rectal lipoma: A case report.

Wei Ran R Xu Wei W Xiao Yuhong Y Zeng Fei F Mao Shengxun S

Medicine 20180901 39

<h4>Rationale</h4>Colonic lipomas are rare benign tumours, usually without any symptoms, and most occur in the caecum and ascending colon. We describe a patient with upper rectal intussusception caused by a giant rectal lipoma; no similar report of this type of case has been published.<h4>Patient concerns</h4>We report the case of a patient who suffered from repeated bloody stools. A wide pedicle polyp (size, 6.5 × 4.5 × 3.5 cm) was detected at the 15th centimetre of the anal canal via an electr ...[more]

PMID: 30278497

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Project description:BackgroundLaparoscopic anterior resection with trans-rectal specimen extraction (NOSES) has been demonstrated as a safe and effective technique in appropriate patients with upper rectal cancer (RC). However, improper selection of RC candidates for NOSES may lead to potential surgical and oncological unsafety as well as complications such as bacteria contamination and anastomotic leak. Unfortunately, no tools are available for evaluating the risk and excluding improper cases before surgery. This study aims to estimate its clinical relevancy and to investigate independent clinical-pathological predictors for identifying candidates for NOSES in patients with upper RC and to develop a validated scoring nomogram to facilitate clinical decision making.MethodsThe study was performed at Shanghai East hospital, a tertiary medical center and teaching hospital. 111 eligible patients with upper RC who underwent elective laparoscopic anterior resection between February and October of 2017 were included in the final analysis. Univariate and multivariate analyses were performed to compare characteristics between the two surgical techniques. Odds ratios (OR) were determined by logistic regression analyses to identify and quantify the clinical relevancy and ability of predictors for identifying NOSES candidate. The nomogram was constructed and characterized by c-index, calibration, bootstrapping validation, ROC curve analysis, and decision curve analysis.ResultsUpper RC patients with successful NOSES tended to be featured with female gender, negative preoperative CEA/CA19-9, decreased mesorectum length (MRL), ratio of diameter (ROD) and ratio of area (ROA) values, while no significant statistical correlations were observed with age, body mass index (BMI), tumor location, and tumor-related biological characteristics (ie., vascular invasion, lymph node count, TNM stages). Furthermore, the two techniques exhibited comparably low incidence of perioperative complications and achieved similar functional results under the standard procedures. The nomogram incorporating three independent preoperative predictors including gender, CEA status and ROD showed a high c-index of 0.814 and considerable reliability, accuracy and clinical net benefit.ConclusionsNOSES for patients with upper RC is multifactorial; while it is a safe and efficient technique if used properly. The nomogram is useful for patient evaluation in the future.

Dataset Information

Laparoscopic segmental resection of the rectum for upper rectal intussusception caused by a giant rectal lipoma: A case report.

Publications

Laparoscopic segmental resection of the rectum for upper rectal intussusception caused by a giant rectal lipoma: A case report.

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